Provider Demographics
NPI:1568446557
Name:GUPTA, AMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 METRO PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2778
Mailing Address - Country:US
Mailing Address - Phone:586-795-4060
Mailing Address - Fax:586-795-5596
Practice Address - Street 1:8244 METRO PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2778
Practice Address - Country:US
Practice Address - Phone:586-795-4060
Practice Address - Fax:586-795-5596
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N34450Medicare ID - Type Unspecified
MIH45824Medicare UPIN
MIN78540025Medicare PIN